The connection between your rib cage and pelvic floor

I recently attended my fourth visceral manipulation course through the Barral Institute, which was focused on the thorax. Your thorax includes your thoracic spine, rib cage, and all of the organs above your diaphragm muscle. I was excited to learn the techniques in this course because I knew they would help my patients who experience mid back pain, neck pain, and headaches, but I also knew these techniques could be helpful for my patients with pelvic floor dysfunction including leaking, constipation, and pelvic organ prolapse. In this blog post, I’m going to talk about why treating the thorax could be key in addressing pelvic floor problems.

First, what is visceral manipulation?

Visceral Manipulation is a gentle manual therapy technique that targets organs and the structures that attach to them including ligaments and fascia. The goal of visceral manipulation is to improve the organs ability to glide and slide against other organs and against the other structures around and attached to them. This helps to improve homeostasis within the body and can help improve digestion, reduce joint pain, and improve many other symptoms which you can read about here.

How does the thoracic cavity affect the pelvic floor?

It’s hard to imagine that tension in the thorax, such as around the lungs, pericardium, or esophagus, may actually be affecting your pelvic floor muscles - but if we look at anatomy and physiology, it actually makes a lot of sense.

Your thorax has a negative pressure, while your abdomen and head have a positive pressure. This balance is important for fluid flow and breathing mechanics.

As you inhale and your diaphragm lowers, your abdomen also expands and your abdominal organs are gently pushed down on by the diaphragm. Your pelvic floor muscles gently lengthen to allow for this downward movement of the organs without discomfort, pressure, or leaking (if you experience any of those symptoms, you may actually have a hypertonic or hypotonic pelvic floor). When you exhale, the opposite motion occurs.

As you can imagine, if there is a restriction above or below the diaphragm (meaning in the thorax or in the abdomen), it can affect the diaphragm itself and the structures on the opposite side of the diaphragm.

So the bottom line is - we want to create good movement, blood flow, and space for nerves throughout the thorax and abdomen. This way the diaphragm and pelvic floor can move in tandem and maintain balance between the thorax and abdomen.

What if the pressure system is off?

Lets say there is a restriction in the thoracic spine or the muscles between the ribs on the back of your rib cage. When you inhale, the back side of your thorax is not able to fully expand, pushing air forward on your rib cage and possibly leading to some thoracic and lumbar extension. This can cause tension in the back side of your pelvic floor muscles as well, which makes it difficult for them to lengthen and absorb force. This ultimately means there is less surface area in the pelvic floor to absorb the pressure down from your inhales, which can contributing to symptoms of pelvic organ prolapse or even leaking with coughing or sneezing.

In this example, you should certainly work on lengthening your glutes and posterior pelvic floor. However, you also need to work on reducing restrictions in the back of the rib cage and retraining your diaphragm to expand back as well. Check out this video of one of my favorite exercises to work on back expansion.

This example can be applied to any restrictions within the thorax and rib cage. This is why it is so important that your pelvic floor therapist looks at pelvic floor function, but also gets outside of the pelvis to determine how the rest of your body may be affecting your pelvic floor’s ability to do its job. The pelvic floor is often the victim of a problem somewhere else.

If you’ve tried pelvic floor therapy with some relief from pelvic floor exercises and internal work, but haven’t seen the long term results you were looking for, I highly recommend seeing a Barral trained provider to determine if visceral manipulation may help you.

If you are local to the Memphis area and are interested in working with me, you can schedule your free 15 minute phone consult or your initial evaluation here.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS, PCES

Want to learn more? Check out my Organ Mobilization Masterclass

This recording of a live masterclass covers what visceral manipulation is, why your organs need to move, why organs may lose movement, and helps you understand the benefits of visceral manipulation. I also teach self-care and self-mobilization techniques, share helpful resources, and show you how to find a provider near you.